Diagnostic yield of combined bronchoscopy and endobronchial ultrasonography, under <scp>L</scp>ung<scp>P</scp>oint guidance for small peripheral pulmonary lesions

Tamiya, Motohiro; Okamoto, Norio; Sasada, Shinji; Shiroyama, Takayuki; Morishita, Naoko; Suzuki, Hidekazu; Yoshida, Emi; Hirashima, Tomonori; Kawahara, Kunimitu; Kawase, Ichiro

doi:10.1111/resp.12095

Cited by 70 publications

(73 citation statements)

References 23 publications

(29 reference statements)

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“…The probe position was an important factor in predicting the diagnostic yield of EBUS-GS-guided TBB. Previous reports have indicated the probe position to be the only significant diagnostic factor (7,8). In the multivariate analysis of the present study, the "within" PPL probe position was found to be significantly associated with a successful diagnosis using radial EBUS (OR=2.542; p=0.007).…”

Section: Discussionsupporting

confidence: 47%

“…The diagnostic yield of EBUS-GS-guided TBB in small (! 30 mm) PPL has been reported to be 63-79% (4)(5)(6)(7)(8). The factors which affect the EBUS-GS diagnostic yield in PPL have been reported; however, some reports have indicated that the probe position is the only independent predictor of the EBUS-guided TBB diagnostic yield (7,8).…”

Section: Introductionmentioning

confidence: 99%

“…30 mm) PPL has been reported to be 63-79% (4)(5)(6)(7)(8). The factors which affect the EBUS-GS diagnostic yield in PPL have been reported; however, some reports have indicated that the probe position is the only independent predictor of the EBUS-guided TBB diagnostic yield (7,8). It is also controversial whether the findings from high-resolution computed tomography (HRCT) before bronchoscopy (e.g., lesion size, location, and CT bronchus sign) are significant diagnostic factors that can be used in addition to the EBUS image.…”

Section: Introductionmentioning

confidence: 99%

“…It is also controversial whether the findings from high-resolution computed tomography (HRCT) before bronchoscopy (e.g., lesion size, location, and CT bronchus sign) are significant diagnostic factors that can be used in addition to the EBUS image. Furthermore, most previous studies have included patients with various benign and malignant diseases, including tuberculosis, nontuberculous mycobacterial infection, organizing pneumonia, lymphoma, and metastatic lung tumors (4,5,7,8). We therefore assessed the diagnostic yield of EBUS-GS-guided TBB and VBN using a computer workstation, ZioStation (Ziosoft, Osaka, Japan) in a study population that only included patients with small peripheral primary lung cancer, and examined the factors that affected EBUS visualization and diagnostic success, particularly in the evaluation of CT findings before bronchoscopy.…”

Section: Introductionmentioning

confidence: 99%

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Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer

et al. 2016

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Objective Endobronchial ultrasonography with a guide sheath (EBUS-GS) and virtual bronchoscopic navigation (VBN) improves the diagnostic yield in patients with peripheral pulmonary lesions (PPLs). Most previous reports on EBUS-GS-guided transbronchial biopsy (TBB) have included patients with benign and malignant diseases. We aimed to determine the factors that predicted a successful diagnosis by EBUS-GS-guided TBB diagnostic in patients with small peripheral lung cancer, with a focus on the high-resolution computed tomography (HRCT) findings before bronchoscopy. Methods We retrospectively reviewed the medical records of 173 consecutive patients with 175 small (! 30 mm) PPLs who were diagnosed with primary lung cancer between June 2010 and October 2013 at Nagoya University Hospital. All patients underwent EBUS-GS-guided TBB with VBN using a ZioStation computer workstation (Ziosoft, Osaka, Japan). We analyzed the patient characteristics, HRCT findings, diagnostic yield, and the diagnostic factors in small peripheral lung carcinoma. Results The EBUS probe position was within the PPL in 83 of the 175 lesions (47%) and 112 (64.0%) cases were successfully diagnosed by EBUS-GS-guided TBB. A univariate analysis revealed that the following factors were associated with a significantly higher diagnostic yield: CT bronchus sign positivity, a lesion of >20 mm in diameter, a solid nodule, and a probe position that was within the lesion. The following factors were not significant: the lesion location, the number of biopsies, and the lung cancer histology. A multivariate analysis revealed that the following factors significantly affected the diagnostic yield: CT bronchus sign positivity [odds ratio (OR) =2.479]; a probe position that was within the lesion (OR=2.542); and a solid nodule (OR=2.304). Conclusion The significant factors that were significantly associated with a successful diagnosis using EBUS-GS-guided TBB in small peripheral lung carcinoma were as follows: CT bronchus sign positivity, a solid nodule, and a probe position that was within the lesion.

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Section: Discussionsupporting

confidence: 47%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer

et al. 2016

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“…Many previous studies (5,7,(14)(15)(16) also suggested that bronchus sign or the probe located in the center of the lesion were positive factors for a higher diagnostic yields of EBUS-GS. Besides, the application of virtual bronchoscope and electromagnetic navigation bronchoscope could assist the probe to reach the target lesion and improve diagnostic accuracy (23)(24)(25). The complication rate of EBUS-GS was 2%, which was not significantly lower than CT-TTNA (13%) in this study.…”

Section: Discussionmentioning

confidence: 58%

Endobronchial ultrasonography with guide sheath versus computed tomography guided transthoracic needle biopsy for peripheral pulmonary lesions: a propensity score matched analysis

et al. 2016

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Background: Computed tomography guided transthoracic needle aspiration (CT-TTNA) and endobronchial ultrasonography with guide sheath (EBUS-GS) transbronchial lung biopsy are important methods for the diagnosis of peripheral pulmonary lesions (PPLs). Without enough evidence, it is controversial which is a better choice for diagnosing PPLs. In this study, we hypothesized that the complication rate of EBUS-GS would be lower than CT-TTNA and the diagnostic accuracy of EBUS-GS were not inferior to CT-TTNA. Methods: This study was a retrospective analysis of a prospective registry with propensity matching.Patients with PPLs were divided into EBUS-GS group and CT-TTNA group according to patients' intent to treatment. Pathological results and procedure related complications of EBUS-GS and CT-TTNA were recorded. Propensity score matching(PSM) was used to eliminate the intergroup bias. Diagnostic yields and complications of two groups were compared. Subgroup analysis was performed to conclude the indications of different procedures. Results: A total of 187 patients (CT-TTNA: 130; EBUS-GS: 57) were enrolled. After propensity score matching, 54 paired patients were included. Diagnostic yield was 81% (44/54) for EBUS-GS and 87% (47/54) for CT-TTNA (P=0.43), respectively. Diagnostic sensitivity in malignancy was 93% (42/45) for CT-TTNA and 79% (37/47) for EUBS-GS (P=0.04). Subgroup analysis revealed that the sensitivity of CT-TTNA was significantly higher in diagnosing of lesions close to the chest wall (100% vs. 80%, P=0.04), and bronchus sign on CT was a predictive factor for accurate diagnosis by EBUS-GS. The overall complication rate was 13% (7/54) for CT-TTNA group, which was not significantly higher than that of EBUS-GS group (2%, P=0.06). Subgroup analysis showed that patients combined with pulmonary comorbidities and lesions apart from chest wall were risk factors for complications of CT-TTNA. Conclusions: Both of the two procedures are effective for the diagnosis of PPLs, but CT-TTNA has a higher diagnostic sensitivity for malignancy. EBUS-GS has fewer complications, and it is more suitable for patients combined with pulmonary comorbidities and lesions with bronchus signs.

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Endoscopic bronchial occlusion with silicone spigots under virtual bronchoscopic navigation

Hayama

Sato

Shiroyama

et al. 2016

Respirology Case Reports

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A 68‐year‐old woman with interstitial lung disease related to dermatomyositis and systemic scleroderma was admitted to our hospital with fever and dyspnoea. Although the fever was reduced after antibiotic therapy, a left pneumothorax suddenly occurred on day 27 after admission. A continuous air leak persisted despite chest drainage with three tubes and repeated pleurodesis. Chest computed tomography (CT) images showed a cavitary lesion with a pinhole in the left upper division, which was suspected to be the affected lesion with the air leak. Virtual bronchoscopic navigation images were constructed from CT data. Bronchial occlusion with Endobronchial Watanabe Spigots (EWSs) was performed on day 52. Two medium‐sized EWSs were inserted into the left B1 + 2a and B1 + 2b, and the air leak stopped immediately. No procedure‐related adverse events occurred. All three chest tubes were successfully removed by day 60. This case demonstrates that virtual bronchoscopic navigation can improve bronchial occlusion procedures using EWSs.

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Diagnostic yield of combined bronchoscopy and endobronchial ultrasonography, under LungPoint guidance for small peripheral pulmonary lesions

Abstract: The combination of EBUS-GS and LungPoint was useful for diagnosing small PPL.

Cited by 70 publications

References 23 publications

Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer

Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer

Endobronchial ultrasonography with guide sheath versus computed tomography guided transthoracic needle biopsy for peripheral pulmonary lesions: a propensity score matched analysis

Endoscopic bronchial occlusion with silicone spigots under virtual bronchoscopic navigation

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